About 10% of all children have protruding ears or jug-ears which can result in teasing and psychosocial problems among children and in some cases cause reduced self-confidence. Among adults, they can result in cosmetic and/or psychological problems.
Protruding ears can also be a physical problem. Some people experience that their ears are easily exposed to sunburns in the summer. Others have difficulty in using a bike/motorcycle helmet.
In Denmark, about 2000 patients with jug-ears are operated on every year. Most often parents of children in preschool age wish to have the child operated on in order to avoid teasing when the child is sent to school.
Aures alatae often occurs within families and has a tendency to manifest itself dominantly hereditary. There is a higher incidence of jug-ears in cases of fetal alcohol syndrome, fetal hydantoin syndrome, some chromosome anomalies, such as Down's syndrome (55% have jug-ears) and Turner's syndrome, and also in case of myopathies, such as muscular dystrophy, and in case of certain cerebral affections, such as anencephaly.
Prominent ears are classified in two types, of which one is lacking or imperfectly developed/pronounced anthelix and the other is high/deep cavum concha. These two types can also occur in combination to different degrees.
The ear begin to assume the final shape in the beginning of the third fetal month where especially the development of helix takes place. This helix grows so fast that it grows past anthelix which does not really begin to be formed until the sixth fetal month. If anthelix during the rest of the fetal life cannot keep up with the growth of helix, a real, congenital deformity in form of a protrusion of the ear is formed. This is due to the fact that a certain angular bending of the auricle, corresponding to anthelix, is not present at birth. In pronounced cases, a very deep cavum concha is seen.
After that the ear grows constantly until about the age of 10 where it reaches a size that approximately corresponds to the adult ear. Eighty-fiver percent of the ear is fully grown after the age of 3. It has turned out, however, that the ear is growing on the vertical plane the entire lifetime, whereas the breadth and angle of the ear in relation to the head do not change very much after the age of 10. The best time for operation would therefore be after the age of 10.
Several experts point out, however, that it would not interfere with the growth of the ear to operate children in the preschool age. The psychosocial problems that often affect the child considerably often carry the greatest weight, and the parents therefore choose, as mentioned above, to have the children operated on before they are sent to school in order to avoid teasing.
The operational treatment of jug-ears began in the nineteenth century. Since then, many different operating methods have been developed for this purpose. Some of the operating methods are simple, others more complicated.
The disadvantage of an operation is that it often gives the patient pain—in some cases even for months or years after the operation. About 20% of the patients feel pain/soreness in the operated ear more than a year after the operation. Eight percent require further operations.
After the operation, the patients have to wear a head bandage, which looks like a turban, for 10 days so that the cartilage can heal in the desired position. Some patients have to sleep with a “nightcap” for 3 weeks before the result is satisfying.
A problem that frequently arises in connection with an operation is the formation of an abnormal cartilage fold (anthelix) with small cartilage prominences left on the ear. Such a formation can be painful to the patient and will be cosmetically unsatisfactorily.
It has been discovered that it is possible to non-surgically or non-invasively correct deformities on the auricle permanently, including jug-ears.
As far as children are concerned, the high content of estrogen in the blood explains why the ear cartilage is soft and ductile. The neonatal ear is soft and yielding. After a few days, the ear becomes more elastic and stiff which is believed to be related to the fall in the relatively high concentration of estradiol in the neonatal child.
The highest concentration of circulating estradiol in the newborn is during the first 72 hours after birth. The concentration then drops quickly. At the age of 6 weeks, the concentration of estradiol is on the same level as in older children. Tests with estrogen-injections thus result in increased yieldingness and reduced elasticity of the ear cartilage in rabbits within 24 hours of injection.
It is known that the elasticity of cartilage depends on the concentration of proteoglycan. Hyaluronic acid, a component part of proteoglycan, is increased in the concentration of estrogen and can therefore be accountable for the yieldingness of the cartilage in the neonatal ear. It is therefore within this period that congenite ear deformities, including jug-ears, can be treated the best without using surgical treatment.
Alterations of cartilage subjected to bending and external stresses have shown that ruptures of the perichondrium of the cartilage emerge, and that there subsequently will be an appositional cartilage growth which corresponds to the perichondrium on the convex side of the bending. The cartilage grows in thickness, and a permanent folding of the cartilage is obtained. This result is also best in the neonatal period.
International Publication No. WO 00/09050 discloses a fixture for non-invasively correcting jug-ears. As shown therein, the fixture is in the form of a clip for squeezing around a chosen zone of the ear in order to affect this zone for a relatively long time with compressive forces. The cartilage in the zone is thereby given a permanent deformation, as ruptures are made in the perichondrium of the cartilage with a subsequent appositional cartilage growth which causes the cartilage to be folded permanently.
This known clip is an especially suited means for non-invasively correcting a patient's external ear. The presence of the clip can, however, to some extent give the patient trouble, especially during the night when the patient is asleep. Furthermore, the clip is, despite its small size, visible, and its presence can therefore be cosmetically embarrassing to the patient.
A small child will see the clip as something unpleasant and irritating from which the child will immediately try to free itself at the risk of damaging the ear.